The Pre-existing Condition Insurance Plan (PCIP) programs in 10 states seem to have covered at least 34 high-risk pregnancies for 3,201 enrollees during the programs’ early months of operations.

Jean Hall, a research professor at the University of Kansas, and Janice Moore, a data manager at the University of Kansas, have included the analysis in a PCIP paper distributed by the Commonwealth Fund, New York.

The PCIP provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) created a federally funded “risk pool” health insurance program for individuals with health problems who have been uninsured for at least 6 months.

The PCIP programs are supposed to offer richer benefits than many state risk pools offer at a cost equivalent to the cost of standard health coverage.

But critics say the cost of the coverage is more than many uninsured people can afford, and that most people with extremely serious health problems already have to have some kind of health coverage to survive and cannot go without coverage for 6 months to qualify for coverage.

Federal regulators only recently let PCIP programs pay fees and commissions to health insurance agents and brokers to encourage them to help consumers apply for PCIP coverage.

Originally, PCIP advocates had suggested that the programs would enroll about 375,000 people in the first year; as of April 31, the programs had a total of only about 21,000 enrollees, according to Hall and Moore.

The program appears to be very important to the people who have enrolled in it, the researchers say.

The researchers looked at the records of 1,485 PCIP enrollees in 10 states who have been enrolled in PCIP for at least 2 months and who have presented at least 3 medical claims.

“These rules were used to limit the sample to people likely to have used services beyond an initial visit for preventive services,” the researchers say.

About 23% of the individuals had claims only for preventive care, acute care unrelated to their underlying conditions, or for accidents or injuries.

Only 9 of the individuals had had a transplant or appeared to need a transplant in the future, but 277 had joint problems, 249 had diabetes or other endocrine problems, and 210 to 230 had psychiatric disorders, cardiovascular disorders or back problems.

During the period reviewed, 34 enrollees needed coverage for high-risk pregnancies, the researchers say.

“Note that the prevalence rates reported in the table likely underestimate actual prevalence because the data are from early program experience when enrollees may not have fully understood or utilized their coverage, and claims may not have been fully processed,” the researchers say.

- Allison Bell

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